The school environment, like the rest of society, is regularly confronted with violence and serious events with a strong traumatic impact . Brutally exposed to a threat to their physical or psychological integrity, to a mortal risk for themselves or others, or even to the spectacle of a horrible death, the subjects involved can experience an experience of total insecurity or loss of control.
In this unexpected, disorganizing and destructive experience of the “reality of death”, victims and witnesses find themselves helpless, as in the Gambetta-Carnot school complex, in Arras, where, this Friday October 13, 2023, a man entered with with a knife, killing a teacher and injuring two other members of the establishment’s staff .
A psychological unit was opened in the Pas-de-Calais high school to accommodate educational staff, students and their parents, as was the case during the tragedy at the Saint-Thomas-d’Aquin high school in Saint-Jean- de-Luz (Pyrénées-Atlantiques), where, on February 22, 2023, Agnès Lassalle, Spanish teacher, died after being stabbed in the middle of class by a student.
Often favored by the media and politicians in the context of potentially traumatic events with a collective dimension, systems of this type are put in place to detect, support and prevent the occurrence of psychological after-effects. Who are the personnel who make them up? How do these cells work and what are their missions?
Let us first recall that, for each individual, the subjective experience of potentially traumatic events is unique, with variable repercussions depending on the degree of exposure to the event, its severity, the personal history of each person (traumatic history, violence , deficiencies, anxiety), the internal resources available to us and the social support we perceive. Those involved may feel intense fear, bewilderment, horror and helplessness.
During the event, or just after, most subjects are in an adapted state of stress, that is to say with effective behaviors in the face of danger. Other people develop a state of overwhelmed stress, that is to say a state of astonishment, excessive agitation, panic flight, or automated behaviors not adapted to the context.
In the days following the event, it is common to experience difficulty sleeping, with nightmares and intrusive thoughts or images of the traumatic scene. These early acute stress reactions are physiological and can be described as normal. However, almost a quarter of those involved, children or adults, may see these symptoms persist and significantly alter their daily lives. We then speak of acute stress disorder in the first month and post-traumatic stress disorder (PTSD) beyond.
PTSD is characterized by symptoms of repetition of thoughts, images and dreams focused on the event, avoidance behaviors with the adoption of strategies and significant efforts to avoid what may remind us of the event ( place, thoughts, activities, people, etc.), an emotional state marked by predominant negative emotions, and symptoms of hypervigilance in a state of permanent alert with concentration disorders and irritability.
This post-traumatic picture can be complicated by anxiety disorders (generalization of fear, phobia, etc.) in 60% of cases, depression in 40% of cases, an increase in the risk of suicide multiplied by four, addictions or even manifestations somatics of psychogenic origin.
Mental first aid
Created after the wave of attacks in 1995 to provide a range of care adapted to mentally injured victims of collective events with high traumatic potential, the medico-psychological emergency cells (CUMP) were gradually structured into a national network.
Located in each departmental SAMU headquarters, they are locally run by a referent psychiatrist and made up of volunteer doctors, nurses and psychologists.
The medical-psychological emergency cells intervene at the exclusive request of the SAMU or the prefecture. They can intervene immediately, within the first 24 hours, or post-immediately up to one month after the event.
The CUMP deploys on site or near the event, for example in the school establishment, in the first hours following the tragedy. It receives additional staff from the national education reception and listening unit (made up of doctors, nurses, psychologists and social workers from national education). The objectives of this early intervention are to provide first psychological aid to the children, adolescents, or adults present. The guiding principles of this type of intervention are proximity, immediacy and the restoration of hope.
The CUMP deploy a system adapted to each situation, in collaboration with national education and emergency services, to re-establish a safe environment as quickly as possible and fight against images of chaos that are harmful to victims, particularly children. .
Promote emotional release
A first step, in consultation with the establishment’s contacts, consists of identifying, among children and adults exposed to the event, the degree of exposure to the traumatic event.
This step is essential to target the different subgroups involved and adapt the treatment according to the degree of exposure. Indeed, collective care without this distinction would deprive direct witnesses of speaking, for fear of causing additional distress among their peers who did not attend the event. Conversely, indirect witnesses may not feel justified in verbalizing their emotions in front of their comrades or colleagues who are direct witnesses, which would lock them into silent suffering.
The immediate care offered aims to soothe the stress and anxiety generated by the event, to alleviate the feeling of isolation or helplessness, to recognize the harm suffered and the appalling and exceptional nature of the event, to restore the adaptive functioning and to mobilize personal resources.
The second step consists of identifying people whose emotional control capacities have been overwhelmed, requiring increased vigilance from CUMP professionals, intensification of calming techniques, and close follow-up in the face of the increased risk of developing PTSD . . Sometimes, a transfer to a hospital setting can be organized when the clinical condition warrants it.
For all people involved, CUMPs use “defusing” techniques , or de-shock interviews , individually or in groups. The goal is to reduce distress by promoting emotional release through the shared factual account of the event, in a safe setting. This makes it possible to initiate the cognitive and emotional integration of the event experienced, to help the subject to regain control over what is happening to them, and to rehumanize them in their relationship with others.
This flexible care is non-intrusive, sometimes allows rapid improvement in the psychological state, and is systematically accompanied by information – adapted to the understanding abilities of the people being cared for – on the possible emergence of “normal or normal” symptoms. pathological” in the following days. The contact details of specialized health professionals to be consulted if necessary are also communicated.
Working with the educational community
The CUMP may be required to intervene within 3 to 10 days, to carry out Post-Immediate Psychotherapeutic Interventions (IPPI). This directive and relatively intrusive psychotherapeutic technique requires specific training, and can be offered individually or to groups of volunteers, homogeneous in terms of exposure, and belonging to the same group before the event.
Its goal is to facilitate the integration of the experienced event, while limiting potentially traumatic effects, by limiting emotional outbursts, legitimizing the emotions felt and correcting inaccurate information. This intervention promotes the resumption of activity and functioning of the group pre-existing the event. It also makes it possible to identify people with emerging PTSD and direct them towards treatment.
Traumatic events are unforgettable. Their occurrence in a school environment can have a lasting impact on the establishment concerned. It involves raising awareness among all professionals in the educational institution and paying specific attention to people affected by the event. Health professionals monitor the risk of traumatic reactivation, which can sometimes occur years later, on birthdays, or during more personal life events. Their mission is then to accompany the child or adult to the appropriate care structures.
Author Bios: Anthony Bray is a Psychiatrist at the Regional Center for Psychotraumatology (CHRU Tours), CUMP 37 and Wissam El-Hage is a Professor of Psychiatry, Head of the CVL Regional Psychotrauma Center both at the University of Tours